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- OPEN ACCESS
Determinants of Unmet Mental Healthcare Needs of Single Adults Who Are Homeless or Vulnerably Housed
- Arnaud Duhoux,
- Tim Aubry,
- John Ecker,
- Rebecca Cherner,
- Ayda Agha,
- Matthew J. To,
- Stephen W. Hwang, and
- Anita Palepu
Persons who are homeless experience higher levels of mental illness, unmet mental healthcare needs, and physical healthcare needs than the general population. This study aimed (1) to determine the reasons contributing to having unmet mental healthcare needs (UMHCN) and (2) to examine the determinants of UMHCN among a representative sample of adults who are homeless or vulnerably housed in three Canadian cities (N=1190). Almost a quarter (23.3%) of the sample reported UMHCN in the past year. The reported reasons for having UMHCN pertained especially to the availability (31.5%), accommodation (22.1%), and acceptability (21.3%) of services. Age, city, and need-for-care variables were associated with UMHCN in multivariate analysis. Implications of the findings for policy and program planning are discussed.Les personnes sans-abri présentent des niveaux plus élevés de maladie mentale, de besoins de soins de santé et de besoins non comblés de soins de santé mentale que la population générale. Cette étude visait (1) à déterminer les raisons des besoins non comblés des soins de santé mentale (BNCSM) et (2) à examiner les déterminants des BNCSM auprès d›un échantillon représentatif d›adultes sans-abri ou logés de façon précaire dans trois villes canadiennes (N = 1190). Près d›un quart (23,3%) de l›échantillon a rapporté des BNCSM lors de l›année passée. Les raisons principales des BNCSM portaient sur la disponibilité (31,5%), l’accommodement (22,1%), et l›acceptabilité (21,3%) des services. L’âge, la ville et les besoins de soins étaient les variables associées aux BNCSM en analyse multivariée. Les implications des résultats pour la planification des services et le développement des politiques sont discutées. - OPEN ACCESS
- Sarah Pakzad,
- Paul-Émile Bourque,
- Jimmy Bourque,
- Tim Aubry,
- Lise Gallant,
- Stefanie R. LeBlanc, and
- John Tivendell
The At Home / Chez Soi demonstration project was conducted to investigate the effectiveness of the Housing First model in 5 Canadian cities. Using a randomized controlled trial design, this study evaluates the impact of this project on the use of health services by people with severe and persistent mental health problems and a history of homelessness in the greater Moncton area. The sample comprised 193 homeless persons, 95 in the control group and 98 in the treatment group. The results show a significant difference between the 2 groups only in the number of days of hospitalization, particularly in the psychiatric unit. Factors associated with the use of health services by people who are homeless and who have severe mental health problems need to be further investigated. - OPEN ACCESSThis paper describes the implementation of Housing First in a small Canadian city. Given that the majority of Housing First research has been conducted in large American cities, providing a Canadian context in a small city contributes significant insights for similarly sized areas. The main objectives were to determine the adaptations made to the Housing First model and the contextual realities that affected implementation. Data were collected from two sources: (a) a fidelity assessment by an external team of experts; and (b) key informant interviews and focus groups with program staff and consumers. Results demonstrate that Housing First can be successfully implemented in a small city but with certain constraints and adaptations, notably more limited consumer choice of housing, challenges related to consumer access to transportation, and adaptations to program staffing. Implications for practice are discussed.
- OPEN ACCESSCet article présente une évaluation formative d'un programme Logement d'abord (Housing First) offert en région rurale. Les deux objectifs consistent à décrire les personnes desservies et comment le modèle Logement d'abord fut adapté afin d'offrir des services en milieu rural. La recherche repose sur une méthodologie mixte. Le volet quantitatif, de nature descriptive, porte sur 23 participants et participantes. Le volet qualitatif s'attarde à ce qui a pu contribuer à l'implantation du modèle et les défis qui subsistent, selon 15 informateurs clés. Les leçons tirées de l'expérience et les retombées pour les politiques et les programmes de logement au Canada sont discutées.
- OPEN ACCESSHousing First (HF) effectively houses the majority of homeless individuals suffering from mental illness; however, a small subset continues to struggle with unstable housing. This paper describes a supportive housing pilot program developed at the Moncton site of the At Home / Chez Soi demonstration project for HF participants who have experienced difficulty achieving housing stability while receiving HF services. Specifically, Peer Supportive Housing (PSH) was created for participants demonstrating ongoing unstable housing in the HF program. Results from structured interviews with five program staff and nine tenants of PSH describe the successes, challenges, and perceived outcomes of the early implementation of the program. PSH can supplement HF, and may help to meet the needs of some tenants who are unable to achieve stable housing after a trial of receiving HF services.
- OPEN ACCESSThe At Home / Chez Soi project, funded by Health Canada through the Mental Health Commission of Canada, involves evaluating the implementation and effectiveness of the Housing First (HF) approach, a complex community-based intervention that addresses homelessness in people with severe and persistent mental illness. This paper examines the perspectives of community partners on the implementation of HF in Moncton, New Brunswick. Engagement varied, but overall, HF was seen as fitting well within the network of existing community resources and filling a long-standing gap in services. Community will for sustaining HF was present, though concerns were expressed about sources for ongoing funding.
- OPEN ACCESSThis paper describes an implementation evaluation of a Court Outreach Program that provides outreach and community-based treatment and support to people with mental illness in the legal system. The paper describes the Court Outreach Program and presents evaluation findings. Program strengths included competent and knowledgeable court outreach staff who contribute to the legal and mental health systems and provide access for clients to a range of community supports and treatments. Challenges included a limited program capacity to serve all potential clients and bottlenecks in the intake/assessment process. Recommendations are made to improve the implementation of the program.
- OPEN ACCESSThe current study evaluated the outcomes of an outreach program that provides individualized services to people with severe mental illness who are legally involved. Client outcomes included increased community ability and reduced homelessness for a group of 45 clients still receiving services from the program, and increased community ability and diminished severity of mental health symptoms for 50 clients who had been discharged from the program. Only 2 of the 50 discharged clients (4%) were found to be incarcerated at termination; 1 other client (2%) was detained at termination through the Ontario Review Board.
- OPEN ACCESS
- Tim Aubry and
- Julye Myner
Fifty-one persons with psychiatric disabilities in housing programs in the Ottawa-Carleton area were compared with a matched sample of 51 community residents on several aspects of community integration and subjective quality of life. Matching criteria included sex and location (i. c., living within one square block). Results showed persons with psychiatric disabilities reporting lower levels of social contact with neighbours and general life satisfaction than community residents. Both groups showed similar levels of physical presence and sense of community in the neighbourhood. Implications of the findings for planning and improving community mental health services are discussed. - OPEN ACCESSUsing results from a formative evaluation, the paper describes family-focused case management (FFCM). FFCM is an innovative community mental health service designed to support both consumers/survivors and their families. The formative evaluation used a multi-informant, multi-method approach to describe FFCM services and assess their quality. Focus groups with program stakeholders produced a “program-logic model” and identified minimum standards for FFCM. Service activities and outcomes defined in the program-logic model were typical of those offered to consumers/survivors in intensive case management programs, but were supplemented with support being offered to their families. Monitoring of service activities showed that the case manager had regular contact with families and offered them a mix of direct and indirect services that corresponded, in most cases, to defined program standards. Interviews with 14 family members and 8 consumers/survivors receiving FFCM services revealed high levels of satisfaction with most aspects of the program. Overall, evaluation findings suggest that intensive case management can be expanded to include providing support to families. Future directions for developing FFCM are discussed.
- OPEN ACCESS
- J. Robert Swenson,
- Tim Aubry,
- Katharine Gillis,
- Colleen Macphee,
- Nicholas Busing,
- Nick Kates,
- Sarah Pantin, and
- Vivien Runnels
This article presents the results of a needs assessment of family physicians and residents concerning the provision of mental health care and an implementation evaluation of a multidisciplinary mental health service demonstration project, linking 2 family practices with mental health services of a general hospital. Family physicians and residents reported that collaborative mental health care provision would enhance but not replace their management of patients with mental health problems. The implementation evaluation found that collaborative care provided by a multidisciplinary mental health team co-located with family physicians was accepted by patients and valued by family physicians. Because of a shortage of family physicians, few patients from the mental health system who lacked family physicians were able to gain access to primary care through this project. - OPEN ACCESSThis article describes recent work to support recommendations for improving Ontario's system of housing for people with serious mental illness. This multifaceted project engaged stakeholders in discussions concerning strategies for improving the system based on (a) values that underlie housing programs, (b) evidence of effective housing practices, (c) the current status of the system, and (d) international practices for monitoring community mental health systems. Stakeholders reviewed summaries of the work and discussed implications for improving the provincial system of housing and supports. Recommendations are made for improving the system, focusing on both regional and provincial level actions.
